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      Apelin/APJ relieve diabetic cardiomyopathy by reducing microvascular dysfunction

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          Abstract

          Microcirculatory injuries had been reported to be involved in diabetic cardiomyopathy, which was mainly related to endothelial cell dysfunction. Apelin, an adipokine that is upregulated in diabetes mellitus, was reported to improve endothelial cell dysfunction and attenuate cardiac insufficiency induced by ischemia and reperfusion. Therefore, it is hypothesized that apelin might be involved in alleviating endothelial cell dysfunction and followed cardiomyopathy in diabetes mellitus. The results showed that apelin improved endothelial cell dysfunction via decreasing apoptosis and expression of adhesion molecules and increasing proliferation, angiogenesis, and expression of E-cadherin, VEGFR 2 and Tie-2 in endothelial cells, which resulted in the attenuation of the capillary permeability in cardiac tissues and following diabetic cardiomyopathy. Meanwhile, the results from endothelial cell-specific APJ knockout mice and cultured endothelial cells confirmed that the effects of apelin on endothelial cells were dependent on APJ and the downstream NFκB pathways. In conclusion, apelin might reduce microvascular dysfunction induced by diabetes mellitus via improving endothelial dysfunction dependent on APJ activated NFκB pathways.

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          Most cited references37

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          Insulin resistance and hyperinsulinaemia in diabetic cardiomyopathy.

          Insulin resistance, type 2 diabetes mellitus and associated hyperinsulinaemia can promote the development of a specific form of cardiomyopathy that is independent of coronary artery disease and hypertension. Termed diabetic cardiomyopathy, this form of cardiomyopathy is a major cause of morbidity and mortality in developed nations, and the prevalence of this condition is rising in parallel with increases in the incidence of obesity and type 2 diabetes mellitus. Of note, female patients seem to be particularly susceptible to the development of this complication of metabolic disease. The diabetic cardiomyopathy observed in insulin- resistant or hyperinsulinaemic states is characterized by impaired myocardial insulin signalling, mitochondrial dysfunction, endoplasmic reticulum stress, impaired calcium homeostasis, abnormal coronary microcirculation, activation of the sympathetic nervous system, activation of the renin-angiotensin-aldosterone system and maladaptive immune responses. These pathophysiological changes result in oxidative stress, fibrosis, hypertrophy, cardiac diastolic dysfunction and eventually systolic heart failure. This Review highlights a surge in diabetic cardiomyopathy research, summarizes current understanding of the molecular mechanisms underpinning this condition and explores potential preventive and therapeutic strategies.
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            Diabetic cardiomyopathy: a hyperglycaemia- and insulin-resistance-induced heart disease

            Diabetic cardiomyopathy is characterised in its early stages by diastolic relaxation abnormalities and later by clinical heart failure in the absence of dyslipidaemia, hypertension and coronary artery disease. Insulin resistance, hyperinsulinaemia and hyperglycaemia are each independent risk factors for the development of diabetic cardiomyopathy. The pathophysiological factors in diabetes that drive the development of cardiomyopathy include systemic metabolic disorders, inappropriate activation of the renin-angiotensin-aldosterone system, subcellular component abnormalities, oxidative stress, inflammation and dysfunctional immune modulation. These abnormalities collectively promote cardiac tissue interstitial fibrosis, cardiac stiffness/diastolic dysfunction and, later, systolic dysfunction, precipitating the syndrome of clinical heart failure. Recent evidence has revealed that dysregulation of coronary endothelial cells and exosomes also contributes to the pathology behind diabetic cardiomyopathy. Herein, we review the relationships among insulin resistance/hyperinsulinaemia, hyperglycaemia and the development of cardiac dysfunction. We summarise the current understanding of the pathophysiological mechanisms in diabetic cardiomyopathy and explore potential preventative and therapeutic strategies.
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              New type of cardiomyopathy associated with diabetic glomerulosclerosis.

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                Author and article information

                Journal
                J Endocrinol
                J Endocrinol
                JOE
                The Journal of Endocrinology
                Bioscientifica Ltd (Bristol )
                0022-0795
                1479-6805
                April 2021
                25 January 2021
                : 249
                : 1
                : 1-18
                Affiliations
                [1 ]School of Basic Medical Sciences , Capital Medical University, Beijing, China
                [2 ]Beijing You An Hospital , Capital Medical University, Beijing, China
                [3 ]Beijing Institute of Hepatology , Beijing, China
                [4 ]Beijing Lab for Cardiovascular Precision Medicine , Beijing, China
                Author notes
                Correspondence should be addressed to X Zeng: megan_zeng@ 123456163.com

                *(B Li and J Yin contributed equally to this work)

                Author information
                http://orcid.org/0000-0002-2553-2244
                Article
                JOE-20-0398
                10.1530/JOE-20-0398
                8052525
                33504680
                c4cb380b-8a8e-45b2-a9e8-35e524c498ca
                © 2021 The authors

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 08 December 2020
                : 25 January 2021
                Categories
                Research

                Endocrinology & Diabetes
                diabetic cardiomyopathy,microcirculatory injuries,endothelial dysfunction,apelin,apj

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